Research database

This Research Database has been developed by HCPC Europe to create an overview of the available research in the field of patient-friendly and adherence packaging. The database is for all members of HCPC Europe. Members can register as a user to get access to the database. Is your organisation not a member yet? Then please register your organisation as a member or contact our Executive Director Ger Standhardt for more information.


Adherence to long-term therapies: evidence for action

This report is based on an exhaustive review of the published literature on the definitions, measurements, epidemiology, economics and interventions applied to nine chronic conditions and risk factors. These are asthma, cancer (palliative care), depression, diabetes, epilepsy, HIV/AIDS, hypertension, tobacco smoking and tuberculosis.

Intended for policy-makers, health managers, and clinical practitioners, this report provides a concise summary of the consequences of poor adherence for health and economics. It also discusses the options available for improving adherence, and demonstrates the potential impact on desired health outcomes and health care budgets. It is hoped that this report will lead to new thinking on policy development and action on adherence to long-term therapies.


Does device make any difference? A real-world retrospective study of insulin treatment among elderly patients with type 2 diabetes

We compared real-world clinical and economic outcomes for insulin glargine treatment administered by disposable pen and traditional vial-and-syringe injections among elderly patients with type 2 diabetes mellitus (T2DM).

Methods:

Using a large database of US retirees, this retrospective longitudinal study examined 1-year follow-up outcomes in patients with T2DM aged 65 years or older who were either insulin naïve and initiated insulin glargine via disposable pen (pen initiators [PI]) or vial (vial initiators [VI]) or were already insulin glargine users but either continued with a vial (vial continuers [VC]) or switched to a disposable pen (pen switchers [PS]).

Results:

There were 7856 propensity-score-matched patients, including 2930 each in the PI and VI cohorts, and 998 each in the VC and PS cohorts. Compared with vial-and-syringe users, the disposable pen users had significantly greater treatment persistence (P < .0001 for both comparisons), duration of persistence (P < .0001 for both), and adherence (P < .01 for both) and lower insulin daily average consumption (P < .05 for both). Compared with the VI cohort, the PI cohort had significantly fewer hypoglycemia-related events (P = .0164). Total health care costs were comparable for the respective matched cohorts.

Conclusions:

In elderly patients with T2DM receiving insulin glargine therapy, initiating or switching to a disposable pen was associated with better treatment persistence and adherence than initiating or continuing with vial-and-syringe, without increased total health care costs. Among insulin-naïve patients, initiating insulin glargine by disposable pen was also associated with significantly reduced risk of hypoglycemia compared with vial-and-syringe patients.


Electronic medication packaging devices and medication adherence: A systematic review

Importance  Medication nonadherence, which has been estimated to affect 28% to 31% of US patients with hypertension, hyperlipidemia, and diabetes, may be improved by electronic medication packaging (EMP) devices (adherence-monitoring devices incorporated into the packaging of a prescription medication).

Objectives  To investigate whether EMP devices are associated with improved adherence and to identify and describe common features of EMP devices.

Evidence Review  Systematic review of peer-reviewed studies testing the effectiveness of EMP systems in the MEDLINE, EMBASE, PsycINFO, CINAHL, International Pharmaceutical Abstracts, and Sociological Abstracts databases from searches conducted to June 13, 2014, with extraction of associations between the interventions and adherence, as well as other key findings. Each study was assessed for bias using the Cochrane Handbook for Systematic Reviews of Interventions; features of EMP devices and interventions were qualitatively assessed.

Findings  Thirty-seven studies (32 randomized and 5 nonrandomized) including 4326 patients met inclusion criteria (10 patient interface–only “simple” interventions and 29 “complex” interventions integrated into the health care system [2 qualified for both categories]). Overall, the effect estimates for differences in mean adherence ranged from a decrease of 2.9% to an increase of 34.0%, and the those for differences in the proportion of patients defined as adherent ranged from a decrease of 8.0% to an increase of 49.5%. We identified 5 common EMP characteristics: recorded dosing events and stored records of adherence, audiovisual reminders to cue dosing, digital displays, real-time monitoring, and feedback on adherence performance.

Conclusions and Relevance  Many varieties of EMP devices exist. However, data supporting their use are limited, with variability in the quality of studies testing EMP devices. Devices integrated into the care delivery system and designed to record dosing events are most frequently associated with improved adherence, compared with other devices. Higher-quality evidence is needed to determine the effect, if any, of these low-cost interventions on medication nonadherence and to identify their most useful components.



Interventions for enhancing medication adherence

Ways to help people follow prescribed medicines

Background Patients who are prescribed medicines take only about half of their doses and many stop treatment entirely. Assisting patients to adhere better to medicines could improve their health, and many studies have tested ways to achieve this.

Question We updated our review from 2007 to answer the question: What are the findings of high‐quality studies that tested ways to assist patients with adhering to their medicines?

Search strategy We retrieved studies published until 11 January 2013. To find relevant studies we searched six online databases and references in other reviews, and we contacted authors of relevant studies and reviews.

Selection criteria We selected studies reporting a randomized controlled trial (RCT) comparing a group receiving an intervention to improve medicine adherence with a group not receiving the intervention. We included trials if they measured both medicine adherence and a clinical outcome (e.g. blood pressure), with at least 80% of patients studied until the end.

Main results The studies differed widely regarding included patients, treatments, adherence intervention types, medicine adherence measurement, and clinical outcomes. Therefore, we could not combine the results in statistical analysis to reach general conclusions, as it would be misleading to suggest that they are comparable. Instead, we provide the key features and findings of each study in tables, and we describe intervention effects in studies of the highest quality. The present update included 109 new studies, bringing the total number to 182. In the 17 studies of the highest quality, interventions were generally complex with several different ways to try to improve medicine adherence. These frequently included enhanced support from family, peers, or allied health professionals such as pharmacists, who often delivered education, counseling, or daily treatment support. Only five of these RCTs improved both medicine adherence and clinical outcomes, and no common characteristics for their success could be identified. Overall, even the most effective interventions did not lead to large improvements.

Authors’ conclusions Characteristics and effects of interventions to improve medicine adherence varied among studies. It is uncertain how medicine adherence can consistently be improved so that the full health benefits of medicines can be realized. We need more advanced methods for researching ways to improve medicine adherence, including better interventions, better ways of measuring adherence, and studies that include sufficient patients to draw conclusions on clinically important effects.


Economic impact of medication non-adherence by disease groups: a systematic review

Objective To determine the economic impact of medication non-adherence across multiple disease groups.

Evidence review A comprehensive literature search was conducted in PubMed and Scopus in September 2017. Studies quantifying the cost of medication non-adherence in relation to economic impact were included. Relevant information was extracted and quality assessed using the Drummond checklist.

Results Seventy-nine individual studies assessing the cost of medication non-adherence across 14 disease groups were included. Wide-scoping cost variations were reported, with lower levels of adherence generally associated with higher total costs. The annual adjusted disease-specific economic cost of non-adherence per person ranged from $949 to $44 190 (in 2015 US$). Costs attributed to ‘all causes’ non-adherence ranged from $5271 to $52 341. Medication possession ratio was the metric most used to calculate patient adherence, with varying cut-off points defining non-adherence. The main indicators used to measure the cost of non-adherence were total cost or total healthcare cost (83% of studies), pharmacy costs (70%), inpatient costs (46%), outpatient costs (50%), emergency department visit costs (27%), medical costs (29%) and hospitalisation costs (18%). Drummond quality assessment yielded 10 studies of high quality with all studies performing partial economic evaluations to varying extents.

Conclusion Medication non-adherence places a significant cost burden on healthcare systems. Current research assessing the economic impact of medication non-adherence is limited and of varying quality, failing to provide adaptable data to influence health policy. The correlation between increased non-adherence and higher disease prevalence should be used to inform policymakers to help circumvent avoidable costs to the healthcare system. Differences in methods make the comparison among studies challenging and an accurate estimation of true magnitude of the cost impossible. Standardisation of the metric measures used to estimate medication non-adherence and development of a streamlined approach to quantify costs is required.


Adherence to long term therapy, evidence for action

This report provides a critical review of what is known about adherence to long-term therapies. This is achieved by looking beyond individual diseases. By including communicable diseases such as tuberculosis and human immunodeficiency virus/acquired immunodeficiency syndrome;mental and neurological conditions such as depression and epilepsy; substance dependence (exemplified by smoking cessation); as well as hypertension, asthma and palliative care for cancer, a broad range of policy options emerges. Furthermore, this broader focus highlights certain common issues that need to be addressed with respect to all chronic conditions regardless of their cause.These are primarily related to the way in which health systems are structured, financed and operated.


OECD Health Working Paper No. 105 (2018)

Despite  mounting  evidence, amassed  for more  than  four  decades, poor  adherence  to medications still affects approximately half of  the population that receives prescriptions, leading to severe  health  complications,  premature  deaths,  and  an  increased  use  of healthcare services. – – – – Poor  adherence is  estimated  to contribute to  nearly 200,000  premature  deaths  in Europe per year. Patients with chronic diseases are particularly vulnerable to poor health  outcomes  if  they  do  not  adhere  to  their  medications. Mortality  rates  for patients with diabetes and heart disease who don’t adhere are nearly twice as high as for those who do adhere.
– It  is  estimated  to  cost  EUR  125  billion in  Europe and USD  105  billion in  the United   States   per   year   in   avoidable   hospitalisations,   emergency   care,   and outpatient visits.
– The  three   most   prevalent   chronic   conditions – diabetes, hypertension, and hyperlipidaemia – stand  out  as  the  diseases  with  the  highest  avoidable  costs,  for which every  extra  USD  spent  on  medications  for  patients who  do  adhere can generate  between  USD  3  to  13 in  savings  on  avoidable emergency  department visits and inpatient hospitalisations alone.

The  prevalence  of medication non-adherence  varies  considerably  across  conditions  and patient groups. Most of the studies used different assessment methods making it difficult to compare adherence rates across health systems. Overall, among patients with diabetes, hypertension, and hyperlipidaemia:
– 4 to 31% of patients never fill their first prescription;
– of  those  who  do  fill  their first  prescription,  only  50  to  70%  are  taking  their medications regularly (i.e. at least 80% of the time); and
– less than half of these patients are still continuing to take their medications within two years of the initial prescription.